HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE`COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "��' Z�J Permit Number:
. -22b
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR:
Address: (los �r1AE-Vr;Ee _Dp" Fr-,1ZT �612C,E f-- 34192
Property Tax ID#: ' (0 Lot No.
Site Plan Name: Block No.
Project Name:
3g VY #
New electrical Meter Second Electrical Meter
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e0( STRUCTI4N fNFt3Et11hATiC1N'
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Additional work to be performed under this permit-check all that apply:
—Mechanical —Gas Tank —Gas Piping —Shutters _Windows/Doors _Pond
—Electric Plumbing —Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction -7 Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: Sewer _Septic Building Height:
01AffERLESSEr � �G4NTRACTOR �
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Name081`'15 A0 106 LEW15 Name:•
Address: I INE 1'9�EE - Company:
City: fi o2�upz("E State: Address:,
Zip Code: / Fax: City: State:
Phone No. f�.5' �� -b��15 Zip Code: Fax:
E-Mail: 1 '�°'I"'�2W( C�1�C��C�1Yf Phone No
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Fill in fee simple Title Holder on next page (if different!
dif erent! _. E-Mail
from the Owner listed above) Stateor"•
County License
If value of construction is 2500 or more,a ECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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(DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
;dip: Phone Zip: Phone:
IFEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
:yip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with.your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your'property. A Notice of Commencement must be recorded in the public records of St..
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
')ignature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder .
STATE OF FLORID STATE OF FLORIDA
COUNTY OF 15- LCOUNTY OF
Sworn-to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
_Ph sical Presence or Online Notarization Physical Presence or Online Notarization
this L7,,j day of `` 20&by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identificat' Personally Known OR Produced Identification
Type of IdentificationN
. Type of Identification
Produced oa,, N Produced
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Signature of Notary Public-St a of Florida) . m U.N (Signature of Notary Public-State of Florida)
Commission No. (Seal) "' °.NEE Commission No. (Seal)
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REVIEWS FRONT ZONING SU RQ PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW R I„ EVIEW REVIEW REVIEW'' ' REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
WAMR ODMM Sr FLFURCIL JL R982
SEWER ._RES NAME L L e
METER 3Z, ____�.....M� l 4 Li r
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S � J SECURITY l]kY SERVICE ADDRESS --
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SAME DAY FEL'
SUBDIYISiON ��L.JC� IAT ELOCIC
OVERTIME FLEE
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FPUACFC PHONE14 ?V VE MCLOSING.DATE
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GUAR.RM This ankatwn hereby request and autironi=tia UtMy io trudge watarand/or wwage dbposai
w vIcs s b the pmamim desired abm in aowdam with ft Uftdcs pcasw or fi is v rues,
LATERAL rim and regule&m4 which by rdeamae am made a past of this cm*act.Applkw agm 10 pw
tie Up7itY pton*gy ft nth amiees m acmdaw with tie astabUshod nft and rWl dw&
S '' 'DOTAL cusromm DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLE.
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SOCIALSEU
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NAMEOFSPOUSE D [.-�G+�15 SPOUSE SOCIAL.SEC 05346-5097
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